Hip Fracture Management Using External Fixation-A Systematic Review

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Anesthesiology

Background:

• High-risk patients with comorbidities face significant risks with general anesthesia for surgery.
• External fixation provides a viable alternative using local or regional anesthesia for intertrochanteric fractures.
• Previous data on external fixation for these patients are limited to small case series.

Purpose of the Study:

• To systematically review and analyze existing literature on external fixation for high-risk patients with intertrochanteric fractures.
• To evaluate the outcomes and complications associated with this surgical technique in a vulnerable patient population.
• To consolidate evidence from small case series for a comprehensive assessment.

Main Methods:

• Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Inclusion of all studies reporting outcomes of external fixation for intertrochanteric fractures in high-risk individuals.
• Analysis of data from 13 publications encompassing 687 patients.

Main Results:

• Consistent reports of successful radiological reduction and complete fracture healing across all included studies.
• Demonstrated reduction in limb length discrepancy and postoperative immobility.
• Observed decrease in pain and improvement in clinical hip outcome scores.
• Shorter operative duration noted with parallel proximal screw placement compared to convergent.
• No significant difference in mortality rates between stable and unstable fracture groups.

Conclusions:

• External fixation is a promising and effective treatment for high-risk patients with intertrochanteric fractures.
• The procedure facilitates fracture reduction, improves functional outcomes, and reduces pain and immobility.
• It accommodates both stable and unstable fractures, though unstable fractures may increase morbidity.
• Parallel proximal pin placement can optimize operative time without affecting mortality or morbidity.
• Preoperative fracture stability assessment is recommended for risk-benefit analysis.